Primary Reattachment Rate Research Articles

Surgical outcomes of inverted internal limiting membrane flap technique for primary rhegmatogenous retinal detachment coexisting with a macular hole.

This retrospective study aimed to evaluate the visual outcomes and foveal restoration in eyes with rhegmatogenous retinal detachment (RRD) and macular hole (MH) following surgery using the inverted internal limiting membrane (ILM) flap technique. We collected data on eyes with coexisting RRD and MH that underwent surgery using the inverted ILM flap technique between January 2016 and December 2018. The primary outcome measures were visual acuity (VA) and optical coherence tomography findings. Of 308 eyes with MH originating from various causes, 8 (2.6%) eyes diagnosed with coexisting RRD and MH treated using the inverted ILM flap technique were included. The average patient age and axial length were 65.00 ± 12.01 years and 23.66 ± 0.77 mm, respectively. The mean preoperative best-corrected VA (BCVA) was 1.84 (spherical equivalent [SE], counting finger) ± 0.32 logMAR and the mean final BCVA had improved significantly to 1.05 (SE, 20/223) ± 0.67 logMAR (P = .017). The primary retinal reattachment, MH closure, and secondary retinal attachment rates were 75% (6/8), 87.5% (7/8), and 100% (7/7), respectively. The inverted ILM flap technique led to significant improvements in anatomical and visual outcomes in patients with coexisting RRD and MH.

Characteristics and surgical outcomes of giant retinal tear associated rhegmatogenous retinal detachment

Giant retinal tear-associated rhegmatogenous retinal detachment (GRT–RRD) presents a significant surgical challenge. Trauma stands out as one of the risk factors. This retrospective case series aims to assess the outcomes of GRT–RRD patients treated with pars plana vitrectomy (PPV), distinguishing between non-trauma and blunt ocular trauma cases. The medical records and relevant retinal imaging of 60 GRT–RRD patients undergoing PPV and followed with a mean (SD) of 21.2 (13.4) months were reviewed (47 were non-trauma-related and 13 were trauma-related). Both the non-trauma and trauma groups exhibited comparable distribution of proliferative vitreoretinopathy grade (P = 0.067). Following the primary operation, there was no statistically significant difference in the proportion of patients achieving single surgery anatomical success between the non-trauma group (27/47 patients, 57.5%) and the trauma-related group (9/13 patients, 69.2%) (P = 0.534). At the final follow-up, 17 patients remained tamponade with silicone oil. Among the remaining 43 patients, 33/34 patients (97.1%) in the non-trauma group and 9/9 patients (100%) in the non-trauma group (P = 0.661) achieved comparable final surgical anatomical success. Additionally the final vision was comparable between the two trauma categories (Snellen equivalent of 20/125 for the non-trauma group and 20/200 for the trauma group, P = 0.331). In multivariable regression, no significant factors related to primary reattachment rate or final vision were identified. Non-penetrating ocular trauma did not emerge as a significant risk factor for recurrent detachment post-surgery. This study supports that PPV outcomes in GRT–RRD patients are unaffected by the ocular trauma association and reports the effectiveness of PPV in managing these patients.

Reattachment rate with pneumatic retinopexy versus pars plana vitrectomy for single break rhegmatogenous retinal detachment

AimTo assess the primary reattachment rate (PARR) in pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) meeting the Pneumatic Retinopexy versus Vitrectomy for the Management...

Twelve-Month Outcomes of Three Episcleral Surgeries in Treatment of Rhegmatogenous Retinal Detachment

Introduction: The aim of this study was to compare the long-term outcomes of conventional scleral buckling (CSB), modified scleral buckling (MSB), and scleral encircling (SE) in the treatment of rhegmatogenous retinal detachment and identify factors influencing the outcomes. Methods: This comparative, retrospective cohort study assigned patients to CSB, MSB, and SE groups. The follow-up was 12 months, and the reattachment rate, complication rate, visual acuity, number of newly discovered tears during surgery, and changes in diopters were compared among the three surgeries. Influential factors on anatomical and functional reattachment were identified. Results: There were no significant differences in the primary reattachment rate, overall complication rate, or best corrected visual acuity at 6 or 12 months among the three groups. The MSB group had a higher number of newly discovered tears during surgery compared with the other two groups. At 12 months of post-surgery, the SE group displayed the greatest change of diopter, whereas the MSB group showed the least change. The surgical approach did not influence the primary reattachment rate. Long-term visual outcomes were influenced by factors including sex, preoperative visual acuity, macular status, and duration of symptoms. Conclusion: MSB is an effective method for treating rhegmatogenous retinal detachment. Its advantages include the ability to identify smaller tears and induce minimal changes in diopter.

The Effect of Steroid Intervention before Vitrectomy for Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment: A Meta-Analysis and Systematic Review

Purpose This meta-analysis discusses the effectiveness of steroid intervention before vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment. Methods We searched PubMed, MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies published until August 2023. We included studies involving: patients with rhegmatogenous retinal detachment associated with choroidal detachment with proliferative vitreoretinopathy; an experimental group that was not administered steroids and a control group that was administered steroids; and assessment of visual acuity, retinal reattachment rate, and complications. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis. Results Two randomized controlled trials and four case-control studies involving 490 eyes were included in the meta-analysis. There were no significant differences in the primary and final retinal reattachment rates after surgery between the steroid and non-steroid groups (primary retinal reattachment rate: odds ratio = 1.01, 95% confidence interval = 0.63–1.63, p = .41; final retinal reattachment rate: odds ratio = 0.82, 95% confidence interval = 0.43–1.59, p = .33). There was no statistically significant difference in postoperative visual acuity improvement between the two groups (odds ratio = 1.19, confidence interval = 0.63–2.25, p = .69). In addition, subgroup analyses of different types of steroids showed that systemic and local administration of steroids had similar results for retinal reattachment rate and visual acuity improvement. Conclusion Patients with rhegmatogenous retinal detachment associated with choroidal detachment who did not receive preoperative steroids achieved the same effect as patients with rhegmatogenous retinal detachment associated with choroidal detachment who did receive preoperative steroids in terms of retinal reattachment rate and visual acuity. It is recommended that patients with rhegmatogenous retinal detachment associated with choroidal detachment undergo surgery as promptly as possible.

SURGICAL DRAINAGE METHODS DURING PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Systematic Review and Meta-Analysis.

To assess efficacy and safety outcomes of subretinal fluid drainage methods during pars plana vitrectomy for rhegmatogenous retinal detachment. A systematic search strategy was conducted for studies published between January 2000 and October 2022. Included studies reported on either the safety or efficacy of two or more drainage methods during pars plana vitrectomy for patients with rhegmatogenous retinal detachment. Two randomized and five observational studies consisting of 1,524 eyes were included. Best-corrected visual acuity at the last study observation and primary reattachment rates were similar across groups. A significantly lower risk of epiretinal membrane formation was associated with draining subretinal fluid through preexisting retinal breaks (risk ratio = 0.70, 95% confidence interval = [0.60, 0.83], P = <0.01, I 2 = 0%) or with perfluorocarbon liquid (risk ratios = 0.70, 95% confidence interval = [0.59, 0.83], P = <0.01, I 2 = 0%) compared with posterior retinotomy. The risk of an abnormal foveal contour was significantly greater in perfluorocarbon liquid-treated eyes relative to posterior retinotomy (risk ratios = 1.56, 95% confidence interval = [1.13, 2.17], P = <0.01, I 2 = 0%). No significant differences were observed in the final best-corrected visual acuity at the last study observation and primary reattachment rates across different drainage methods. There remains limited information on the topic, so future research is warranted.

Surgical managements for rhegmatogenous retinal detachment: A network meta-analysis of randomized controlled trial.

Rhegmatogenous retinal detachment (RRD) is the most common ophthalmic emergency threatening vision, with an incidence ranging from 6.3 to 17.9 per 100,000 people per year. However, optimal surgical management of RRD remains controversial. This network meta-analysis compared the efficacy and safety of different surgical options in patients with RRD. We systematically searched PubMed, Embase, Cochrane Library and Web of science for randomized controlled trials (RCT) from inception to 24th September 2023. Frequentist network meta-analyses with the random-effects model was used to synthesize data. The risk of bias for the included RCTs was evaluated using the Cochrane tool for assessing risk of bias, and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. And we performed the network meta-analysis utilizing R 4.1.3 software and Stata 16SE. A total of 19 RCTs enrolled 2589 eyes were included. With high-to-very low certainty of evidence, compared with pneumatic retinopexy (PR), scleral buckling (SB) (odd ratio (OR) = 0.52, 95% confidence interval (CI) [0.30; 0.91]), pars plana vitrectomy (PPV) (OR = 2.35, 95% CI [1.32; 4.20]), PPV+SB (OR = 2.59, 95% CI [1.32; 5.09]) and PPV combined with phacomulsification (PCV) (OR = 7.72, 95% CI [1.07; 55.87]) were more effect in improving primary reattachment rate; for postoperative 6-month vision, SB was superior to PPV+SB (mean difference (MD) = 0.14, 95% CI [0.01; 0.27]). When compared with SB, PPV (OR = 5.27, 95% CI [3.13; 8.86]) and PPV+SB (OR = 10.12, 95% CI [4.31; 23.77]) shows a higher incidence of postoperative cataract progression. Compared to PR, the same is true for PPV (OR = 7.51, 95% CI [3.33; 16.91]) and PPV+SB (OR = 14.43, 95% CI [4.97; 41.93]). PR appears to be associated with a lower rate of primary reattachment rate and postoperative cataract progression. In view of the small sample sizes of the included studies and the low certainty of evidence, these findings must be interpreted with caution. A large number of high-quality trials should be conducted to verify the effects of different surgical techniques in the future.

Biomarkers in retinal detachment surgery. How can we improve visual outcomes

Rhegmatogenous retinal detachment (RRD) is associated with separation of the neurosensory retina from the RPE, leading to visual field defect and potential reduction of central vision. Despite significant improvement in primary and final reattachment rate exceeding 90% and 98% respectively, functional outcomes are still difficult to predict and vary widely. In cases with macular involvement several factors have been implicated in the final visual recovery. These biomarkers are either related to individual risk factors (e.g., duration of symptoms, age, high myopia, and concomitant retinal disease),or to peri and postoperative factors (time to surgery, type of surgery, day of the week, experience of surgeon, positioning before and after surgery, and follow‐up management). With the availability of high‐resolution imaging modalities additional biomarkers have emerged, facilitating further more accurate prediction of visual outcome. Incorporating retinal detachment biomarkers into the daily clinical practice is essential to provide more effective patient counselling and potentially modify the visual rehabilitation process.

Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment in Elderly Patients

To assess clinical outcomes in elderly patients aged ≥ 75 years who underwent pneumatic retinopexy (PnR) for primary rhegmatogenous retinal detachment (RRD). Retrospective cohort study. Patients aged ≥ 75 years with primary RRD undergoing PnR. This study evaluates clinical outcomes among eligible patients who presented from October 1, 2010, to December 31, 2022, with a minimum of 3 months' follow-up. There were no limitations with respect to the number, size, or location of retinal breaks. Exclusion criteria included significant proliferative vitreoretinopathy or previous retinal detachment repair in the index eye, inability to maintain the postoperative posturing requirements or inability to carry out adequate examination of the peripheral retina because of media opacity. Lens status did not impact the decision to offer PnR. Pneumatic retinopexy primary anatomic reattachment rate and postoperative best corrected visual acuity (BCVA) at 3 months. Eighty patients with a mean age of 80.6 ± 4.6 years were included in this study; 35% (28/80) were phakic and 34% (27/80) presented with a fovea-on RRD. The mean number of breaks in the detached retina was 1.52 ± 1.13, and the mean number of quadrants of detached retina was 2.35 ± 0.93. The primary anatomic reattachment rate at 3 months after PnR was 78.8% (63/80), whereas the remaining 21.2% (17/80) failed PnR and underwent an operating room procedure. There was a statistically significant improvement in logarithm of the minimum angle of resolution (logMAR) BCVA from baseline to 3 months (1.29 ± 0.94 and 0.69 ± 0.67, respectively, P < 0.001). A subgroup analysis that only included patients aged > 80 years was also performed, with a total of 39 patients with a mean age of 84.4 ± 3.5 years. The primary anatomic reattachment rate with PnR in this subgroup was 74.4% (29/39), with a statistically significant improvement in BCVA from baseline to 3months (1.4 ± 1.05 and 0.77 ± 0.70, respectively; P= 0.004). Elderly patients treated with PnR for primary RRD had relatively comparable primary anatomic reattachment rates with other surgical techniques such as pars plana vitrectomy and scleral buckle. Pneumatic retinopexy is an effective, minimally invasive office-based procedure that may be desirable for some elderly patients. The authors have no proprietary or commercial interest in any materials discussed in this article.

A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy

To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system. Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis. We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses. Pneumatic retinopexy was compared with PPV in all analyses. The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications. In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR. Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Clinical Outcomes of 27-Gauge Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment Repair.

Purpose: To analyze the clinical outcomes of 27-gauge pars plana vitrectomy (PPV) repair of diabetic tractional retinal detachment (TRD) of various severities. Methods: This retrospective case series examined the outcomes of 27-gauge PPV to repair diabetic TRD from 2016 to 2020. The effect of medical and ophthalmologic history parameters and baseline detachment characteristics on visual acuity (VA) and retinal reattachment was analyzed. A grading system was established to stage the severity of the baseline vitreoretinal traction or detachment and compare the visual and anatomic outcomes between stages. Results: The study comprised 79 eyes (79 patients). The overall redetachment rate was 10.1% (8/79). The proportion of eyes with severe visual impairment (worse than 20/200) decreased from 81.0% (64/79) preoperatively to 56.9% (37/65) 6 months postoperatively (P < .001). Worse preoperative logMAR VA was associated with greater odds of redetachment (P = .017) and worse postoperative VA (P < .001). Insulin dependence was associated with better VA at 6 months (P = .017). A shorter known duration of diabetes (P = .026) and evidence of neovascularization of the iris (NVI) or angle (P = .004) were associated with worse visual outcomes. Eyes with detachment involving the posterior pole extending beyond the equator had worse VA at 6 months (P = .048). Conclusions: The primary reattachment rate after 27-gauge PPV was 89.9%. There was significant VA improvement, with a roughly 40% reduction in the number of eyes with severe visual impairment by the final follow-up. Insulin dependence, duration of diabetes, presence of NVI before surgery, and baseline posterior pole detachment extending beyond the equator were predictors of visual outcomes.

Surgical Audit for the Outcome of Primary Rhegmatogenous Retinal Detachment Repair in the Kingdom of Bahrain.

The purpose of the study was to audit the primary and final success rate for primary rhegmatogenous retinal detachment (RRD) surgery performed between 2017 and 2022 at the Department of Ophthalmology in Salmanyia Medical Complex, the Kingdom of Bahrain. In addition, secondary outcomes for our study include assessments of risk factors for recurrence, final visual outcomes and complication rates. Prospective observational study showed data analysis of case series for 75 RRD patients operated during the study period. All patients who met the inclusion criteria were included in the study and evaluated by a specialized vitreoretinal surgeon before and after their operation. All patients were operated by the same surgeon (M.A) in the study period. Data collected from the hospital's electronic medical recording system (I-Seha) include macular state, pre- and postoperative best-corrected visual acuity, duration of symptoms, the presence of proliferative vitreoretinopathy (PVR), retinal breaks and their locations, any ocular comorbidities associated in the perioperative period such as increase in intraocular pressure or development of cataract, and operative notes related to the type of primary, secondary, and tertiary surgery if needed. A total number of 70 eyes from 70 patients with the majority of male patients (74.28%, n = 52) were included in the study. The mean age of the participants was 54.75 years (range: 11-91 years). Most of the patients 48.57% presented within 6 days of symptoms. Nearly 77.1% of the operated cases were macula off, whereas 22.85% were macula on. Thirty-six of the eyes (51.4%) had complex RRD with a combination of PVR (34.2%). Sixty-three of the eyes (51.4%) underwent standard 23G pars plana vitrectomy, while the combined surgery with a scleral buckle was performed on 9 eyes (12.8%). Five patients underwent pneumatic retinopexy and two patients had primary scleral buckles. Combined phacoemulsification with vitrectomy in selected cases was performed on 13 eyes (18.5%). Different tamponading agents were used 35 eyes (50%) silicon oil, 17 eyes (24%) C3F8, and 18 eyes (25%) SF6. The primary reattachment rate after one operation was 77.1% (54 eyes). The final reattachment rate following a second or third procedure was 95.7%. The mean postoperative visual acuity was 6/18 (range: 6/6 to hand motions). Thirty percent of the cohort of patients had a visual acuity of 6/12 or better. Sixteen out of the 70 eyes redetached (22.8%) and 10 of those eyes (62.5%) were classified as "complex" preoperatively which is thought to be a significant risk factor for failure. Our audit overall met international success rates despite the presence of some complex scenarios which required multiple surgical interventions. The primary use of gas or silicon oil did not influence reattachment rates but had a statistical significance when it came to final visual outcomes.

Air versus Perfluoropropane Gas in Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A 3-Year Retrospective Study

Introduction: This study aimed to compare anatomical outcomes of air and perfluoropropane gas (C3F8) tamponade in pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD). Methods: In this retrospective study, data were gathered from 578 patients (578 eyes) with RRD. The follow-up records of all 578 patients that underwent primary vitrectomy for RRD with air or C3F8 were examined and analyzed. Surgical outcomes of the two groups were compared. Results: A total of 342 eyes were treated with air and 236 with C3F8. The mean follow-up period was 37.65 ± 2.33 months. Baseline and preoperative clinical characteristics were similar between groups, but the period to intraocular bubble disappearance (p < 0.0001), intraocular pressure on the first postoperative day (p < 0.0001), number of cases with intraocular pressure >21 mm Hg within 3 days post-surgery (p < 0.0001), and the number with intraocular pressure >21 mm Hg during follow-up (p = 0.0002) differed significantly between groups. Primary reattachment rates for air and C3F8 groups were 95.03% and 95.34%, respectively. Clinical characteristics were similar in those with and without successful reattachment, and the frequency of new or unclosed breaks was similar between the two groups. There was no significant difference in two groups according to the presence or absence of inferior retinal breaks and inferior detached quadrants. Univariate and multivariate logistic regression identified no risk factor for surgical failure. Conclusions: Air showed equivalent effects to C3F8, with a shorter period to intraocular bubble disappearance, less risk of postoperative intraocular hypertension, and less expense.

Heavy silicone oil tamponade: a multicentre experience

ObjectiveTo report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications.Methods and analysisPatients from seven vitreoretinal units...

Microscope-assisted pneumatic retinopexy for the management of primary rhegmatogenous retinal detachment.

Outcomes of pneumatic retinopexy (PnR) using surgical microscope, wide-angle viewing system, and chandelier endoilluminator (microscope-assisted pneumatic retinopexy) for primary rhegmatogenous retinal detachment (RRD). Retrospective study. 43 consecutive eyes with RRD undergoing microscope-assisted PnR surgery (MAPR) were analysed. Inclusion criteria comprehend phakic eyes with single retinal break or a group of breaks in detached retina in the same quadrant above 8- and 4-o'clock meridians. Follow-up was at least 6 months. Of the 43 eyes, a total of 25 (58%) presented preoperatively a single retinal break, 15 (35%) had two retinal breaks in the same quadrant and 3 (7%) presented three or more retinal breaks in the same quadrant. Other retinal breaks not observed preoperatively were discovered intraoperatively in 12 eyes (28%). In 9 (21%) the missed retinal breaks were in the same quadrant as the main diagnosed break(s), while 3 (7%) had missed retinal breaks in a different one. These 3 eyes as no longer adhering to the PnR indication criteria switched intraoperatively to other surgical procedures and were excluded in the reattachment rate results. The total primary reattachment rate with MAPR was achieved in 37 eyes (92.5%). No significant BCVA changes were observed postoperatively. MAPR is an effective and safe surgical option, it allows to work with both hands free and provides an adequate visualization of the retina during the procedure minimizing the risk of missed retinal breaks potentially leading to surgical failure.

Outcomes and eye care knowledge in rhegmatogenous retinal detachment patients with a history of laser refractive surgery for myopia.

PurposeTo investigate the surgical outcomes and eye care knowledge of patients with rhegmatogenous retinal detachment (RRD) who had previously undergone laser refractive surgery (LRS) for myopia in a myopia epidemic area.MethodsThis retrospective study included patients with primary RRD who underwent surgery and had a history of LRS for myopia at a tertiary medical center. Data were reviewed from medical charts to analyse the surgical outcomes. Questions about eye care knowledge and attitude toward myopia and LRS were obtained.ResultsA total of 774 patients underwent RRD surgery, among whom 341 (44%) had myopia > −3 dioptres, 66% of whom had high myopia. Thirty eyes of 26 patients had a history of LRS for myopia. The mean age of patients with a history of LRS was significantly lower than that of those without a history of LRS (45.7 ± 2.9 years vs. 53.8 ± 1.0, p < 0.001). The mean pre-LRS spherical equivalent was −8.66 ± 0.92 (range: −3.00–−12.00) dioptres. In more than half the patients (n = 15, 57.7%), the interval between LRS and RRD was more than 10 years. The primary retinal reattachment rate was only 60%, whereas the final retinal reattachment rate was 93%. The mean final visual acuity (VA) improved from a 20/286 to 20/105 (p = 0.006). Linear mixed model analysis showed factors of male sex and macular detachment were significant with poor visual outcome (p = 0.046 and 0.008) Eye care knowledge obtained from the 19 RRD patients with history of LRS, 47% of patients (9/19) mistakenly thought that LRS could cure myopia and its complications, and 63% of patients were less willing to visit an ophthalmologist because uncorrected VA improvement after LRS. Eighty-four percent thought that proper knowledge and more education about LRS and myopia for the public are important.ConclusionIn the RRD patients with a history of LRS for myopia, their age was relative younger. Male sex and macular detachment were associated with poor visual outcome. More education with proper knowledge of LRS, myopia and RRD is recommended for the patients to prevent or early detect the occurrence of RRD.

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

Purpose: The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB + PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear. Methods: A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000–Jun 2021 that reported on the efficacy and/or safety following SB and SB + PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated. Results: Across 18 studies, 3912 SB and 3300 SB + PPV eyes were included. Final BCVA was nonsignificantly different between SB and SB + PPV (20/38 vs. 20/66 Snellen; WMD = −0.11 LogMAR; 95% CI: [–0.29, 0.07]; p = 0.23). Primary reattachment rate was similar between procedures (p = 0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR = 1.03; 95% CI: [1.00, 1.06]; p = 0.04). Compared to SB + PPV, SB alone had a significantly lower risk of postoperative macular edema (RR = 0.69; 95% CI: [0.47, 1.00]; p = 0.05) and cataract formation (RR = 0.34; 95% CI: [0.12, 0.96]; p = 0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB + PPV. Conclusions: There was no significant difference in final BCVA between SB + PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.

INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE COEXISTENT WITH RHEGMATOGENOUS RETINAL DETACHMENT.

To report the clinical features and treatment outcomes of patients with macular hole coexistent with rhegmatogenous retinal detachment surgically treated with pars plana vitrectomy and inverted internal limiting membrane flap technique. Eleven consecutive patients with rhegmatogenous retinal detachment and macular hole who underwent vitrectomy and internal limiting membrane peeling with the inverted flap technique between December 2017 and February 2021 were retrospectively evaluated. The main outcome measures were retinal reattachment rate, macular hole closure rate, and postoperative best-corrected visual acuity. A nonsystematic literature review was performed to compare the study outcomes with those previously reported. The primary retinal reattachment rate was 90% (10/11) with one surgery and 100% with 2 surgical procedures. Macular hole closure was achieved in all patients (11/11). All patients showed an improvement in visual acuity at the final postoperative visit, and the mean postoperative best-corrected visual acuity was 0.60 ± 0.32 logarithm of the minimum angle of resolution (20/80 Snellen equivalent). Vitrectomy with the inverted internal limiting membrane flap technique achieved not only favorable anatomical retinal reattachment rates but also an encouraging recovery of central macular anatomy and visual function in patients with macular hole coexistent with rhegmatogenous retinal detachment.

Surgical success in the management of retinal detachment secondary to a giant retinal tear

Background: The purpose of this study was to describe anatomical and visual outcomes after scleral buckling, pars plana vitrectomy, and the use of silicone oil as a tamponade in the management of retinal detachment associated with giant retinal tears (GRT). Material and methods: A retrospective descriptive chart review was conducted for cases with an initial presentation of rhegmatogenous retinal detachments associated with GRT. Patients underwent surgical management by a single surgeon and had follow-ups at least 12 months. Results: We included 32 eyes of 32 patients. All eyes underwent 23G pars plana vitrectomy with scleral buckling and silicone oil as tamponade. Lensectomy was performed for all phakic eyes. Mean pre-operative best-corrected visual acuity (BCVA) was 20/800, and post-operative was 20/40 (20/20-LP). The mean follow-up was 18 months. Fourteen eyes (45%) had grade C proliferative vitreoretinopathy, and five eyes (16%) had GRT more than 180º. The primary reattachment rate was 93%, and the overall final anatomical success rate was 100%. Transient intraocular pressure (IOP) elevation was found in 6 (19%), and after silicone oil removal surgery, no patient required antihypertensive management. Conclusion: High rates of anatomical success support the management of GRT-associated retinal detachment with scleral buckling, lensectomy, par plana vitrectomy, and the use of silicone oil as tamponade. Removal of silicone oil helps to avoid complications secondary to its emulsification, such as glaucoma and band keratopathy.

Supplemental Scleral Buckle for the Management of Rhegmatogenous Retinal Detachment by Pars Plana Vitrectomy: A Meta-Analysis of Randomized Controlled Trials

Objectives: The present review aimed to synthesize evidence from randomized controlled trials (RCTs) that compared outcomes of pars plana vitrectomy (PPV) with and without a supplementary scleral buckle (SB) for management of rhegmatogenous retinal detachment (RRD). Methods: The authors searched MEDLINE, Embase, and CENTRAL to identify RCTs in English that compared PPV with and without supplemental SB. Risk of bias was assessed according to the Cochrane Risk of Bias 2 tool. We present risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) estimated using random-effects meta-analyses. Results: We identified 6 RCTs involving 705 eyes. Primary reattachment (6 studies, 345 eyes PPV, 324 eyes PPV + SB; RR 0.99, 95% CI 0.93–1.06, I² = 0%, p = 0.78) and final anatomic success rates (4 studies, 272 eyes PPV, 267 eyes PPV + SB; RR 1.00, 95% CI 0.98–1.02, I² = 0%, p = 0.89) were similar between the 2 groups. Postoperative visual acuity improvement (5 studies, 244 eyes PPV, 222 eyes PPV + SB; MD 6.09 letters, 95% CI -0.47–12.64, I² = 69%, p = 0.07) and frequency of adverse events (6 studies, 1,294 observations PPV, 1,221 observations PPV + SB; RR 0.76, 95% CI 0.57–1.01, I² = 25%, p = 0.06) likewise did not differ significantly between the treatment groups. Conclusion: Low-certainty evidence from RCTs did not demonstrate a benefit in placement of a supplemental SB during vitrectomy for management of RRD in the current analysis. Additional high-quality trials are needed to provide more precise estimates of the effect.